i used to work night shift at a few skilled nursing facilities. some of the patients were hospice patients. when the hospice patients passed away i called their physician, families and hospice nurses to let them know. i have never seen hospice nurses came to see the patient when the patient passed away at the midnight or like between 2-5 am. or at least i don't remember if they came, or i might not have noticed when they came. do hospice nurses document the fact (the patient passed away) and discharge the patient after they received the phone call but not normally visit the patient? or depends on the situation, they visit the patient as a night time on-call? i just wonder.
Apr 9, '12
In my experience of working for two different hospice companies, the answer to this question usually depends on the individual facility. Some facilities make it a policy that they want the on-call hospice nurse to come out and pronounce the patient, make the necessary phone calls, and support the family, and some facilities just call to notify the hospice on-call nurse but have one of their nurses do all of the above except notify the hospice medical director and DME company, which is the responsibility of the on-call hospice nurse. When I was a weekend on-call hospice nurse, it worked both ways. I went out to several facilities when one of our patients would die there, and there were other facilities that would just call to notify me that our patient died but tell me that I didn't need to come out. The hospice nurse always documents the death and how the death call was addressed, either with a visit or a phone call, and in my experience, the responsibility of discharging the patient from the system was up to the office staff the following day.
Apr 9, '12
yup...depends upon the situation.
Generally we ask if the facility needs or wants us to visit...especially if the family is NOT coming to the bedside.
The only reason that we don't attend the death of our patient's in LTC/SNF is because we are not required to pronounce and provide post mortem care, but we can if that would help the facility. Don't ever be afraid to ask for a visit!
Apr 9, '12
At my facility, the floor nurse calls the hospice nurse. We also call the doctor and the family and the funeral home that had been chosen by the patient and/or family. Normally the hospice nurse doesn't come out unless we request them too. All the hospice nurses I have called have asked me if I wanted them to come out but I don't recall a time I did ask that they come out. We had two different companies (at seperate times) and it went that way for both.
Apr 10, '12
Wow, I cannot believe the hospice nurses did not attend all deaths. In my 10years of hospice, We ALWAYS attend ALL deaths. The facility calls us, and they should call the families (but many times they do not do that either) we come out, pronounce, call Medical Examiner. The police are not called unless it is facility protocol. We call the funeral home and we wait until the body is picked up before we leave. Makes for a long death event at times, but the only time we would not show up is if there was some sort of weather event taking place.
Sometimes I wish in the middle of the night we would not have to go!!!!
Apr 10, '12
I agree with Jeannepaul, we attended to each death. The staff RN at a LTCF could pronounce (if the nurse was comfortable doing that) and we took care of everthing else. The 3am calls were the worst and I usually had to drive the 50+ miles.
Apr 10, '12
I agree that we should attend the deaths. We make the on call nurses document that they offered a visit with the name and credentials of the person who declined...just to make sure they are not "cutting corners". I think it is important to offer that level of support to the facility staff because it is labor and paper intensive when the patient dies.
Apr 11, '12
Agreed, and there are times that a patient dies and the facility does everything and then calls the hospice nurse after the fact. I know that happened more than once when I was working after hours on-call. It's not like a visit wasn't offered, of course, but when they don't call you until everything is already done, and they are perfectly fine with doing it that way, it isn't because the hospice nurse was cutting corners.
The first hospice that I worked for covered seven large counties and at night on the weekends we only had one on-call nurse. I suppose the nurses at some of the facilities just got tired of waiting for us to arrive and found it easier to just do it themselves and move on with their shift. Fortunately, the hospice that I work for now only covers one county and this doesn't seem to be as much of an issue.
Jun 26, '12
We attend every death, unless we don't get notified until several hours later. It wasn't always that way, and I know most facilities can "handle it", but if hospice has been involved with a patient and family, at the time of death seems the most obvious time that we should be there. Even if the family doesn't come to the facility, they usually appreciate the fact that we have made the visit and speak to them, offering condolences and support if needed.
Jun 27, '12
I've never seen a hospice nurse come after a death in my snf. I've always called the hospice to let them know, they call the physician, family, and mortuary...but never come out. Which is fine.
Jul 1, '12
I have worked for 4 different hospices; all required to go to all deaths. Yes, it's tiring especially early morning hours, but the family will remember us and what we did. Only once have I not gone; the LTCF called after the funeral home picked up the pt and family did not come at all.
Jul 1, '12
It's really hard to make a blanket statement about this. I make visits if it would be helpful, to anyone, to do so. Usually SNF's don't want a visit - they've tidied up the patient and, unless family is there and need emotional support (often the SNF staff know them better than we do), there's not much reason to go. I DO notify the doctor and mortuary, and family if that's the staff's preference (again, they may have a relationship and prefer to call themselves). In my county we don't have to pronounce or involve the coroner.
My question to the caller now is "Would it be a comfort if I came out?" I don't want to shade the question to elicit a "no", but I also don't want to intrude; sometimes it feels that way, if the family is very matter of fact. Often it feels like the visit makes a huge difference, but sometimes it feels like they have to entertain me. I suspect this is a dicey issue for many hospice nurses.
Jul 1, '12
I have worked for two hospice companies in the past ten years. Both companies require that a nurse attend each and every death.
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